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General NPI Number Information
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NPI Number | 1033155247
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Entity Type | Individual
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Provider Name | FREDERICK WILLIAM RANDOLPH MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 2607 RHAWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3038
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Country | US
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Telephone | 215-333-0304
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Fax | 215-333-1402
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Provider Business Mailing Address
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Address Line | 2607 RHAWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3038
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Country | US
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Telephone | 215-333-0304
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Fax | 215-333-1402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | D0019085
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD447333
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License Number State | PA
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